International Clinical and Medical Case Reports Journal (ISSN: 2832-5788) | Volume 5, Issue 7 | Research Article | Open Access DOI
Ryan Marra*
Ryan Marra, OMS-2* and Mark Sangimino, MD
Department of Orthopaedic Surgery, Duquesne University Nasuti College of Osteopathic Medicine, Pittsburgh, PA, USA
*Correspondence to: Ryan Marra
Fulltext PDFBackground: Total hip and knee arthroplasty are highly effective procedures for end-stage degenerative joint disease, yet substantial geographic variation in utilization and patient financial burden persists.Objective: To evaluate geographic variation in utilization rates and patient out-of-pocket (OOP) costs associated with total hip and knee arthroplasty across California.Methods: A retrospective population-based analysis was conducted using statewide healthcare utilization data from 2018-2023. County-level total hip and knee arthroplasty encounters were analysed. Utilization rates were calculated per 1,000 member-months. Median OOP costs and proportion of patients with zero OOP responsibility were assessed. Geographic variation was evaluated using Kruskal–Wallis testing and multivariable linear regression identified factors associated with utilization.Results: A total of 1,180 county-year observations were included. Mean arthroplasty utilization was 0.325 procedures per 1,000 member-months, with substantial variation across counties. Utilization differed significantly by geographic region (p < 0.001). Medicare coverage was independently associated with higher utilization, while Medi-Cal coverage was associated with lower utilization. Median OOP cost averaged approximately $1,400 and only 25% of patients had no OOP responsibility. Higher OOP burden and lower rates of zero-cost coverage were associated with variation in utilization across regions.Conclusion: Significant geographic variation exists in total hip and knee arthroplasty utilization across California, accompanied by meaningful differences in patient financial burden. Insurance type and cost-sharing structure appear to be important drivers of utilization patterns. These findings highlight persistent disparities in access to arthroplasty care and support the need for policies addressing both geographic and financial barriers.
Significant geographic; Financial barriers; Median OOP costs
Marra R, Sangimino M. Geographic Variation and Patient Financial Burden in Total Hip and Knee Arthroplasty: A Population-Based Analysis Across California. Int Clinc Med Case Rep Jour. 2026;5(7):1-7.